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Individual

DR. MARK WAYNE LANTZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
2555 PHILLIPS FIELD RD, FAIRBANKS, AK 99709-3933
(907) 328-2980
(907) 456-2914
Mailing address
2555 PHILLIPS FIELD RD, FAIRBANKS, AK 99709-3933
(907) 328-2980
(907) 456-2914

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
171851
AK
152W00000X
Optometrist
1934DT
KY
152W00000X
Optometrist
4901004481
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
900A210610
BCBSM
MI
Enumeration date
04/18/2008
Last updated
04/01/2021
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